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HomeMy WebLinkAbout17809-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of. the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z-18452 Date OCTOBER 6, 1989 THIS CERTIFIES that the building ADDITION Location of Property SO INLET LANE GREENPORT N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 43 Block 05 Lot 06 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 26, 1989 pursuant to which Bu.i.lding Permit No. 17809-Z dated FEBRUARY 9 1989 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOSEPH & MARIANNE MACY (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING SLIP 7/24/1989 PLUMBERS CERTIFICATION DATED MASTER PLUMBING 7/25/89 c uilding Inspector Rev. 1/81 r~osaa xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TFiE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)` N~ ~ 1 Z 8 ~ 9 Z Dote ....c..l..a:e~t........1 19 ~.9 Permission is hereby granted to: ~ . ta °t'N.....a~2.d?:...:~.....c~-r~,....~~1.^~..1~3.....~........'. ..\I..~~4,Q.R.~-!!~f~.......... sue........ ct premises lC~~t ...~.b....~!:1~~.....~a^.:4?:n.........~.~r.4rfM.. . ~~:~a:;:..........~a,~„y,,.....~ q ,J~ 5..~ Caunhj Tax Map No. 1000 Section Block ......~.5........gLot No..~.~a pursuant to application dated .~fkws~.v........r~. ~e 19...1.,, and approved by the building Inspector. Fee Bu ing Inspector Rev. 6/30/80 t __ti FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 218240 Date AUGUST 4, 1989 THIS CERTIFIES that the building ADDITION Location of Property 80 INLET LANE GREENPORT House No. Street Hamlet County Tax Map No. 1000 Section 43 Block OS Lot 06 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JAN. 26, 1989 Aursuant to which Building Permit No. 178092 dated FEB. 9 1989 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION TO EXISTING ONE FAMILY DWELLING. CONDITIONAL: SLIDING DOORS ON 2nd FLOOR TO BE FASTENED SHUT AT ALL TIMES. The certificate is issued to JOSEPH & MARIANNE MACY (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING SLIP 7j24J89 PLUMBERS CERTIFICATION DATED MASTER PLUMBING 7/27/89 !~d/ ~~.!?mj Bui1 'ng Inspector Rev, 1/81 • 1 TOWN OF SOUTNOLD r BUILDING DRPART2ICNT TOWN QALL SOUTUOLD, NEW YORK 11971 765 - 1802 ,,,,w APPLICATION FOR CERTIFICATE OF OCCIIPANCY ~ 1 DATE. NEW CONSTRUCTION ._.._..OLD OR PRE-E%ISTING BUILDING...... VACANT LAND..... Location of Property.. UOU~E~NO. l - -S-TREE-T-- -IIAMLH7/~~/~J - Ovner or Owners of Property •c-~S. .~~J'•_~~`-%~~' ~.(.~loZ~~y!/y~~..~ . Lf .r- \ > County Taa Map No. 1000 Section . , Block LoC C . Subdivision Filed Map ._......Lot........_. Permi[ :io. ..........Dace of Permit .._...._..ApPlicant Qealth Dept. Approval Underwriters Approval..........._.. Planning Board Approval Reques[ for Temporary Ce/r/C/~ificate Final Certificate FCC S LL b m L C C C d: ~ . - APPLTCANT."'e:~6~~i-~~:.e' y C~ ~~~~a ocr - s ' BLDG UENT. TOWN Of SOUYNOID rev• 10/14/88 6L,oc. 38y13 C o Z Is"ys ~ ~ FORM NO. 6 ~ TOWN OF SOUTUOLD BIIILDING DEPARTMENT TOWN NALT. 7b5 - 1802 APPLICATION FOR aERTIFICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must bu filed in typewriter OR ink and submitted to the Building Inspgc'„);,paF~aa~tti~iSe` following; for qew buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusuallnatural or topographic features. 2_ Final approval of Dea,lth Dept- of water supply and sewerage-disposal(S-9 farm). 3, Approval of electrical installation from Board of Fire Underwriters. , 4. Sworn statement from ,plumber certifying that solder used in system contains less than 2/10 of 1z lead.; 5. Commercial buildings,i industrial buildings, multiple residences and similar, buildings and installations, a certificate of code compliance £rom the Architect „ or Engineer responsible for the building. 6. Submit Planning Board', Approval of completed site plan requirements. B. For existing buildings (Prior to April 9, 1957] non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. A,properly completed application, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show single and separate ownership of Lhe entire lot prior to April 9, 1957. If a Certificate of O~cupancy is denied, the Building Inspector shall state the reasons therefor in writing to khe applicant. 3. Date of any housing c~de or safety inspection of buildings or premises, or other pertinent infozmationjrequired to prepare a certificate. C. For Vacant Land Certificate o£ Occupancy: 1. An application for vaunt land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership of the entire lot prior Co April 9, 1957 shall also accompany the application. If a Certificate o£ Occupancy is denied, the Building Inspector shall state the zeasogs therefor in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00, Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over 5 years' - $10.00 4. Vacant Land Certificate o£ Occupancy - $20.OD 5. Updated Certi£icat~e of Occupancy - $50.00 6. Temporary Certificate of Occupancy --$25.00 Residential $50.00 Commercial i f i rev. 10/14/S8 _ a ~ r ~,;~;~~P~~ 0l~ ~,,v . S r ~ ~ i~ Memorandum from . ~ BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, $OUTHOLD, N. Y. 11971 765-1802 Sept. 26, 1989 Dear Mr. Macy: I am enclosing an application for you. In order to update your C.O. please fill out the application and return it to us along with your check for $50.00. Thank you. r~ 0 TEL. 765-1802 pS~~Fpt,`~~p; TOWN OF SOYJTIIO]LD ,N: " ~ OFFICE OF BUILDIIQG INSPECTOR P.O. BOX 728 r" TOWN HALL on901 ~ ~~~`r SOUTHOLD, N.Y. 11971 , D~~~~ V~~ E R T I F I CAT I O N ~u~ z 7 ~ BLDG. DEPT. ~ CSC 70WNOFSOU7NOLD Date tJ~ Building Permit No. /~ts'~!'~ Owner --~U.S~fJ ~~/.J/~'i/?a~~r ~J/~fj(p~lj ase print) Plumber //~~/7-G~ ~~~r,~~al~~ 7~ (pleas prin I certify that the solder used in the water supply system contains less than 2/10 of to lead. , (plumber's signature) Sworn to befor me this r a7~day of ~ , / , ~v ~ LJ 19~. ,,pp No 'y Pu is Clotary Public County y~11LMA G• MA'n'NEWs NWaN P"~'q~1888~Yyodt ~romlesi f ~ I~n~ ~.31~j8,gj~.• CI::LD 5~:~' "?-=i)~i ~~'u iii: i; OPSM LN7° _ ~ n 1. ~ ~ H O H ..E1 FOUi7DATI0N (1st) o(~ C P (n fi FOUNDATION (2nd) _ _ 2. ~ cS' rr/ ~ r ROUG FRAME & ~ O,G ' ~ PLUMBING ~ H s ~ 3. ~ II7SULATI027 PER N. Y. yn 'J STATE ENERGY CODE m 4. S y FI;dAL ~rp ~ A ITIOIIAL COMMENT'S. o ~ ^ Q ~w~t'~L 8~f~ 31a1~ti ~s~ So ~ ~J _ x ro H ~ ' y ~ t M .D ~ b z x ro A r H ' - 5 C7 . m •o H ` TOWN OF SOUTllOLU BUILDING DEPART2IENT TOWN NALL SOUTUOLD, NEW YORK 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE.. ..7: NEW CONSTRUCTION ~0~ LPL PRE-E%ISTING IIUILDING._....VACANT LAND...._... O ~ ! ~ ( ~ ~r P Y•• ~ ..1:.~"'~G... .'fir 6i C_L`,'r~,~S~.iL.. Location of Pro ert 7` UOUSE NO. STREET UAMLET ~ i -7 Ovner or Ovners of Property..:~~~./,.7~. k,(ti~~~G.~~~~~.,,,/+~-,„/ t`~'~',_,,,,_., County Taa Map No. 1000 Section ,~-G Block .~:5,. Lot ..h~IP. q ~ i q, Subdivision_./.~7....C.14Y~~.......... PiledpMap ~.jlY/~~..Lot.~./.`,~',_//./ Permit No. .(./.~~!°`:Date of Permit .~J,.~,%AppLicant ~.1~.1~~~!-ka~~/~..4~'C~' Bealth Dept. Approval ....UV~~......... Underwriters Approval Planning Board Approval Request for Temporary Cert~_iyE~icaCe Final Certificate Fee SubmiCCed: $..~-~~~~?.,_,~~/~Q~ Go.~~ I`d ~y0 1 ~ /OQ APPLICANT.. A~~~i ?j d ~~~1~~ JUL 2 7 ~ TOWN OF SOU HOLD rev, 10/14/88 0 L r Ji. ~ FORM NO. 6 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN HALL 765 - 1802 APPLICATION FOR CF~'RTYPICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must be~,filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Hearth Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that solder used in system contains less than 2/10 of IZ lead., 5. Commercial buildings,llindustrial buildings, multiple residences and similar. buildings and installe'tions, a certificate of code compliance from the Architect or Engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (Prior to April 9, 1957 non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. A properly completed application, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show single and separate ownership of the entire lot prior to April 9, 1957. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in wr~~iCing to the applicant, 3. Date of any dousing code or safety inspection of buildings or premises, or other pertinent information required to prepare a certificate. C. For Vacant Land Certificate of Occupancy: 1. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership of the entire lot prior to April 9, 1957 shall also accompany the application. If a'~~Certificate of Occupancy is denied, the $uilding Inspector shall state the reason's therefor in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwel~ing $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses $50.00. 2. Certificate of Occupancy oa pre-existing dwelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 , 5. IIpdated Certificate of Occupancy - $50.00 6. Temporary Certific~Ce of Occupancy - $25.00 Residential $50.00 Commercial i ~ I' ~ j I ~I rev. 10/14/38 ~~1~~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T ( ] !ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ 7 FRAMING ( FINAL REMARKS: CQ DATE ~ INSPECTOR ~7~~ ~ 765-1802 BUILDING DEPT. INSPECTION [ J FOUNDATION 1ST (~GH PLBG. [ J FOUNDATION 2ND [ INSULATION [ ]FRAMING ( ]FINAL REMARKS: ----~~o.~,l DATE ~ INSPECTOR y i~~~9 7ss-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION ZND (INSULATION [ ]FRAMING [ ]FINAL REMARKS: d t e DATE I S INSPECTOR L ` 765-1802 BurLDtNG Deer. INSPECTION [ ]FOUNDATION 1ST [i]°ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [FRAMING [ ]FINAL REMARK : c~ ~ r~~ emu., O < DATE ~ ~ tNSPE~CTOR - 765-1802 BUILDING DEPT. tNSPECTtt?N [ ]FOUNDATION 1ST ( ] ROUGN PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [~RANIING [ ]FINAL REIIAARKS: ~isrj --v T-----rl - ~ ~ DATE ~ INSPECTOR / i ~~o ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ f (!!1q i(„ BUREAU OF ELECTRICITY ~ ~ 88 JOHN STREET, NEW YORK, NEW YORK 10038 Date ~~"Jtd."~9` C~1 +.~3~~ Application No. on file ~''~~~i:7'2~~f~ii~ `~~1~~~{~ THIS CERTIFIES THAT only the eluctricol equipment oa described below oral introduced 6y the applicant named on the above application nun>ber in the premises of ~ ffR.~70S1;1'ft 57~,t`Y, Ff4's '72~7.,H`t` h.i~F;!N;; C'RxoFi~}"?'R`1', 3~eY.. 1st F(. L"J 2nd FL .SeK•t[on Block Lot in [hefollowinR hrcotiun; ? Basement ~y d)(3 9 ~7IY1~Y r} arts exmnined on andfound to be in cun+plim+cc with the reyu[remenLa q/this Board. FIXTURE ECEPTAClES SWITCHES FIXTURES RANGES COOKING DECKS OYENS DI'aH WASHERS E%HAUST FANS OUTLE}S INCANDESCENT FLUORESCENT OTHER AMT. K.W AMT. K. W AMT. K.W. AMT K W AMi H.P DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gElt UNIT HEATERS MULTI.OUTIET DIMMERS AMi K. W. Oll H P. GAS N. P AMT. NO. A W. G AMT. AMP. AMT. AMPS TRANS. AMT H V SYSTEMS AMT. WAi75 t/0.OF FEET I SHRVIGE DISCONNECT NO.OF S E R V I C E AMT AMP TYPE METER ]W i W. 3W ~ 9 3W R A' dW NO OF CC. COND. A W. G NO OF HI-LEG A W G' NO OF NEUTRALS A W. G EQUIP. PERd OF CG COND. OF HbLEG OF NEUTRAL OTHER APPARATUS: N'.C.a;-f 5G%IUkCk: 3iZr'S"~;,••PYJft': -:I ~ALV~'~'QHF' t', Pb'tA9'ti 1,13f;a#10!3-#~: C~T.6(~CIxS 3,r~tdF: , „ CF.).}; ~ {{y', GENERAL MANAGER s ii.4$2', (s1Y E'UR'C; il'Y, J..1.4<9~7 "l,}. Per I This certificate must not be altered in any manner; return to fhe office of the Board iF incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. _ mu+~i~ ~ , i ~ ro~ ~ ~ ~ ~ ~f o C da LI ~ ~ Q z~i-~w~ ~ ~ Rr r ~ S' y~ b~ : 1, • wv' ~ ~ ~ ~ h~ , ~ w w ~ ~ ~ n ~ ~ is H W ~ - ~ - ~ ~ ~ 00 ~ ~ ~ b A C~~f I. ' to er ~ ,Q U ~ ~ u ~ r ~ ~ p b =~s,. a~ y A ~ ~ ~ ~ c D ~ ~E a ~ ~ y s Z ,r ~ ; y 0~ ~A ° tip ~t ; . m 0 ~ ~ ~ ~ ~ ~ E • ~ ~h; I w ~ ~ ~ ~ o ~ C ~ ~r~~ . ~ pa w Vt O pz V1 `J ~ ~ ,u ~ ~ ~~T H y ~ M ~W N QJ d ~1 , ~ ~ _ ~ '~~y+N ~O c G G b ~a Cam. sa, F~ "G' H U G (~j ~ ~ ~ ~ ~~;C'+ [[i~J fA i _ ~ ~ ~p ~~rt. ~i ~ ~c ~ ~4v ~ C < << Zm A f ~ ~ ~ ~ ~ , : Q' ~ ~ ~ c ~ ~1 f u~ , ~o~ u{ \ ; 5~; Q"J ~ r.~ tE'yJo ~t+~ t~ Ji r~ P \ H ~J /5, m1 ' X1'1 , ~ ~ ~ ~ : +f~}~9 ~ 7 ~ C^? r;~. ' . ~ ~ ~ ~~azZ„fit C~jV ~ ~ ENV ~q~r o ~ fi .rC ~ ~ ~ ~ ~ ~,w cp' x + n C.. ~ t~ 1f1~~'~~~') E { pP... '1 .J Il ! f..; 1 \ BOARD OF HEALTH ~ . , f ~ ` 4 3 SETS O F PLANS hr2c~P . 4~ (~s FORM NO. 1 ~r SURVEY ' " ~ Jp~ 2'~ I9S9 ; if TOWN OF SOUTHOLD CHECK ~.IR`~.p.'....... , , , , BUILDING DEPARTMENT sErTlc FORM . TOWfv0~S0UTli0Lt5 E SOUTHOLD, N.Y. 11871 NOTIFY ...,_.....,,~p.,,,~.m..~m....~,~<...,..,~ TEL.: 765-1802 CALL 477.-. 7 6~3.... . L•xantined • 9..., 19~°.I, MAIL T0: n Approved ~~-.4~!~1?a^.'!~..9.., 19 . ~ Permit No. 1.7. ~..9. 1Z4 `~j 0 ' ~ Disapproved a/c o cv (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ,January 26,, , , , lygg INSTRUCTIONS a. Tlus application must be completely Called in by tgpewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Buildin; Inspector will issued a Building Permit to the applicant. Such perm: ,shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions ar alterations, or for removal or demolition, as herein describes ' The applicant a~rces to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t~ admit authorized inspectors on premises and in building for necessary inspections. .Ri,~hard .Saetta .C, .Inc... . (Signature of applicant, or name, if a corporanon) 4 .$49ti,e4. A,L1ey,..Gr:senport.•Nit • i1:1•~l. ~ • (Mailing address of applicant) • State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Ger}~~a.I..Conti'acter Name of owner of premises .....~Iosegh, J:..at?d. J"IaZ~dJlr30. M;3.GY• • • • • • . (as on the tax roll or latest deed) !f applicant is a corp ration, signature of duly authorized officer. Vice- President (Name and title of corporate officer) Builder's License No. . 130,~~)-I~ . . . . . . Plumber's License No . . Electrician's License No. , ,1049, ;E , , , , , , , , , , , , , Other Trade's License No . . 1. Location of land on which proposed work will be done. . b7Q....3~ .In1et...Lana ...6reanport...DT. Y..................... House Number Street Hamlet County Tax tap No. 1000 Section .43; 00 , , , , , , , , , , , Bock 5 Lot .6:000 • . _ . • . Subdivision Filed Aiap No. Lot . (Name) 2. State existing use and occupancy of premtses and intended use and occupancy of proposed construction: a.Existmguscandoccupancy...l2esidential,,,,,,_„•.._ b. Intended use and occupancy ,.Residential.~..~,~c9-~t~~..Q~ . . 3. ,Nature of work (check which applicable): New Building Addition . X Nteration . 'Repair Removal Demolition Othcr_1Vo . , . (Description) 4. Estimated Cost ...70 ~ 000 . . . Fee . (to be paid on filing this application) 5. If dtveliing, number of dwelling units 1........... Number of dwelling units on each (]oor . , N/A If garage, number of cars N/A, , , , , , , , • , , , , 6. If business, commercial or mixed occupancy, spcci(y nahrrc and extent of cachaype of use•.. N/A • • • 7. Dimensions of existing structures, if any: Front .20:•, . .Rear . ,7p , , , , . Depth 33.'.:4"....... . Hcicht .1 a:: F':....... Num~cr of Stories . 1 . Dimensions of same stricture wt De, th , , , , th alterations or additions: Front Same............ Rear ..Satn~ . .p Same ',IIcight„Same.•••..,•...•,•,NumbcrofStories,Same• 8. Dimenstons of entire new constrtction: Front , Same , , , , , , , Rcar . ,Same • , , , . , • , pepth , Same• Hcigitt ...Same Number of Stories Same ~ . . . 9. Size of lot: Front Rcar Depth 10. Date of Purchase ~ .Name of Pormcr Owner . ll. Zone or use district in whichprcntisesaresituated•,Residential,,,,,,••,,,,,•,•,,,,,,,,,•,,,,,,,,•,,, 12. Does proposed construction violate any zoning law, ordinance or regulation: , ,NO• • , , , , , • , , , , , , , , , , , , , , , l3. Will lot be regraded ...NR !I ..................Will excess fill be removed from premises: Yes No 14. Name of Owner of premises Joseph&i~.ziaririq~`~ddress 109..Posb..R4dd P~~on• o. 333-7675 Name of Architect . TJa.vzzenGe .xUth?.7.7 M~~AYddress 1315 ,Inlet ,La~~a P1ion~~org.Yj.7~i 652• Name of Contractor R...Saett}a .Gett'':l . COYIt.z. klsl¢irs5s~ ..4,$gpt] eS .$~J~eY. Phone No. 47.7= i 63.3• • • ' 15.Is this property locaCed with in 300 -feet of a tidal wetland? *YIiS.yi..NO.... *If yes, Southold Town~Trustees Permit may be required. PLOT DIAGRAh1 Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block [}umber or description according to deed, and show street names and indicate whether interior or corner lot. See attached plane. i ~I I~ i' STATE OF \E\V YOIf Ii, ~ S COUN•Cl' OF . rStl~~4~k........ ' .....RvbfX.t< , Saqua..........'I . being duly sworn, deposes and says that he is The applicant (Name of individual signi~ig contract) above named. tleis[he....,Contracter,CorpPrate,Officer.ti•, (Contractor, agent, corporate officer, eteJ oC said owner or owners, and is duly' authorised to perform or,•have performed the said work and to make and Gle this application; that all statements contai~ted in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application tiled therewith. Sworn to bcfon me this 26th .............day oC.LJantzarY. , 19 89. Suffolk , tiotary Pub Coun[Y . ~IINDAJ. 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